The opinion of the court was delivered by: William W. Caldwell United States District Judge
(Magistrate Judge Mannion)
Plaintiff, Jennifer J. Ames, filed this appeal under 42 U.S.C. § 405(g) seeking review of the decision of defendant, Michael J. Astrue, the Commissioner of Social Security, denying her application for supplemental security income under the Social Security Act. See 42 U.S.C. §§ 1381-1383f. We are considering Plaintiff's objections to the report and recommendation of the magistrate judge, which recommends that we deny the appeal.
Plaintiff argues she is disabled from diabetes insipidus, adrenal insufficiency, depression and hypothyroidism. Chiefly, she claims that her diabetes insipidus causes excessive urination at times even with medication and that her hypothyroidism and adrenal insufficiency cause fatigue that requires her to often nap three to four hours daily. As a result, she is unable to work.
She makes the following objections to the magistrate judge's report. First, the magistrate judge erred in deciding that the ALJ correctly assessed her usual daily activities, mainly, in the ALJ's rejection of her fatigue, inability to control her urination, and the extent of her depression. Second, the magistrate judge erred in deciding that the ALJ's hypothetical question to the vocational expert included all of Plaintiff's impairments and limitations.
After review of the objections, the briefs on appeal and the record, we agree with an argument that Plaintiff made on appeal, that the ALJ failed to provide a specific discussion of the evidence that led him to decide that Plaintiff's subjective complaints of disabling symptoms were against "the great weight of the documentary medical evidence," as the ALJ put it.
The case must therefore be remanded on that basis alone, but before we do so we will request additional briefing on another issue emphasized for the first time in Plaintiff's objections to the magistrate judge's report. It is an issue that arose in the hearing before the ALJ but which was not explored at that time - Plaintiff's inability to afford her medications and if so, whether this makes her disabled under the act because without the medications she apparently cannot function at all, and may indeed die if they are not provided.
The magistrate judge's report provides a comprehensive background. We provide here only a synopsis. Plaintiff was diagnosed with Cushing's syndrome as the result of an adenoma on her pituitary gland. In November 2002, at the age of seventeen, she underwent two operations to remove any adenomas from the gland. In the process, the gland was destroyed. As an aftereffect of the surgery, Plaintiff suffers from diabetes insipidus, adrenal insufficiency, ovarian failure, hypothyroidism, and hypopituitarism. She also has a growth hormone deficiency.
At the time of her disability hearing in March 2006, Plaintiff was a 21-year-old college student. She testified that the diabetes insipidus causes excessive urination, and she takes a drug called DDAVP for this. However, the drug wears off at irregular times during the day. When she takes another dose, it takes about an hour for it to take effect, and during this time she must frequently use the bathroom. Hypothyroidism and adrenal insufficiency cause fatigue. She takes Synthroid for the hypothyroidism and Cortef for adrenal insufficiency, but testified that she often must sleep three to four hours daily on three to four days during the workweek. She takes Wellbutrin for her depression. She also complained about excessive diarrhea and constipation, but said her main concerns about the workplace were being able to use the bathroom and her fatigue.
Plaintiff's financial inability to obtain her medications came out in regard to her testimony concerning her emotional condition. She testified to concern about obtaining her medications since she had no private health insurance and only had access to the medications because Pennsylvania was covering her under medicaid ...